Migraine: translational challenges, novel therapies and disease modification

Migraine is the most common neurological disorder, which after stroke confers the greatest neurological disability in the working population. As with other disorders of brain function, pathophysiological processes are more difficult to delineate, notwithstanding the biological complexities and clinical heterogeneity of the disorder. The current review will outline the framework upon which mechanistic pathways have been predicated. It will examine bench to bedside models: what we have learned from those which have been unsuccessful and address those which have borne fruit, presenting the clinical and exploratory insights gained. In the second part the more recent successes in drug therapeutics are summarised, from clinical trials to real world observations and limitations. With this in sight, the third part emphasises the need to reframe goals towards longer-term disease modification, addressing the impact of confounding comorbidities and moving towards a biopsychosocial model of pain.